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Errors in Surgical Instrument Handling

Many patients do not think much about the surgical instruments that will be used in their surgery. The patients will likely be under anesthesia and have no idea what instruments are actually used in their surgery. At the very least, patients should expect the instruments will be clean and sterile. Unfortunately, errors in surgical instrument processing can increase the risk of infection and injury. 

Sterilization and Cleaning of Surgical Instruments

A lot of things used in a surgical environment are used only once and thrown away. However, surgical instruments are used and reused time and time again. It is important that these instruments are properly processed, sterilized, and repackaged before each new use to make the surgery as safe as possible. 

There are a number of errors that can occur in a surgical setting after surgery, during processing, or before a new surgery. Problems in processing surgical equipment include:

  • Improper categorization
  • Incomplete packages
  • Instrument malfunction
  • Wrong packaging tag
  • Wrong packaging material
  • Wrong instrument count
  • Failing to follow manufacturers’ processing recommendations 
  • Improper pre-treatment
  • Confinement and containment of dirty instruments
  • Improper sterilization procedures

One of the most cited problems is caused simply because there is not a standardized processing and packing procedure for instruments in the same categories. 

Improper Sterilization

According to a study by The Joint Commission, two elements of performance could help reduce the risk of infection in surgery centers and hospitals. This includes using standardized sterilization procedures, training staff, and certifying hospitals and healthcare centers that used quality improvement techniques to produce better results in surgical instrument processing. 

One hospital in Seattle improved sterilization through identifying and categorizing errors through the use of a daily defect sheet. After reviewing the data, the organization created separate steps related to assembling and packaging the instruments and rearranging the sterile processing workspace. The hospital also developed a checklist, sterilization certification program, and regularly sought feedback. After implementing the new sterilization strategies, the hospital reported sterilization error rates decreased 50%. 

How Surgical Instrument Errors Can Increase the Risk of Infection

Surgical site infections are one of the most common healthcare-associated infections (HAIs)  in the medical industry. According to a study published in the New England Journal of Medicine, surgical-site infection accounts for almost a quarter of all HAIs. There are potentially harmful bacteria, viruses, and fungus all around us. However, these things may not be dangerous until they find a way into the sterile environment inside the body. A contaminated scalpel, scissors, or clamps can introduce the infection directly inside the body. 

Discovering Surgical Instrument Errors 

It can be difficult to find out about a surgical instrument handling error, especially when the patient was unconscious during the procedure. Infections may develop over time and it may take days or weeks before an infection is properly identified. During this time, an infection can cause serious injury, including tissue damage, organ damage, shock, amputation, or death. 

If you believe that you were infected during surgery, you may be a victim of malpractice. The Gilman & Bedigian legal team can answer your questions and concerns. To speak with a member of our medical malpractice team, fill out an online case evaluation form or call (800) 529-6162 today.


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